Illness Perceptions After Myocardial Infarction: Relations to Fatigue, Emotional Distress, and Health-Related Quality of Life

Alsén, Pia; Brink, Eva; Persson, Lars-Olof; Brändström, Yvonne; Karlson, Björn W.

Journal of Cardiovascular Nursing. 25(2):E1-E10, March/April 2010.

doi: 10.1097/JCN.0b013e3181c6dcfd

Background and Research Objective: Health-related quality of life (HRQoL) is impaired in patients after a myocardial infarction (MI), and fatigue and depression are common health complaints among these patients. Patients' own beliefs about their illness (illness perceptions) influence health behavior and health outcomes. The aim if the present study was to examine illness perception and its association with self-reported HRQoL, fatigue, and emotional distress among patients with MI. Subjects and Methods: The sample consisted of 204 patients who had had MI and who completed the questionnaires during the first week in the hospital and 4 months after the MI. The questionnaires used were the Illness Perception Questionnaire, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, and the Short Form Health Survey (SF-36). Results: Patient's illness perception changed over time from a more acute to a more chronic perception of illness, and beliefs in personal and treatment control of MI had decreased. Furthermore, these negative beliefs were associated with worse experiences of fatigue and lowered HRQoL. Conclusions: Patients' illness perceptions influence health outcomes after an MI. Supporting MI patients in increasing their perception of personal control could be a primary nursing strategy in rehabilitation programs aimed at facilitating health behavior, decreasing experiences of fatigue, and increasing HRQoL.

Anna-Mari Aalto¹, Arja R. Aro^{2, 3}, John Weinman⁴, Monique Heijmans⁵, Kristiina Manderbacka¹ and Marko Elovainio¹

(1)	Health services research, STAKES (National research and development centre for welfare and health), Lintulahdenkuja 4, Helsinki, Finn-00531, Finland

(2)	University of Southern Denmark, Esbjerg, Denmark

(3)	Erasmus Medical Center, Rotterdam, The Netherlands

(4)	Unit of Psychology, United Medical and Dental School of Guy’s and St Thomas’s Hospitals, KCL, London, UK

(5)	NIVEL, Utrecht, The Netherlands

Accepted: 26 April 2006 Published online: 7 July 2006

Abstract This one-year follow-up study (n = 130 at baseline, n =2745 at follow-up, aged 45–74 years) examined the relationship of patients’ perceptions of coronary heart disease (CHD) and illness-related factors with global health status and global quality of life (QOL) ratings. The independent variables were CHD history (myocardial infarction, revascularisation), CHD severity (use of nitrates, CHD risk factors and co-morbidities) and illness perceptions. In multivariate regression analysis, CHD history and severity explained 13% of variance in global health status and 8% in global QOL ratings at the baseline. Illness perceptions increased the share of explained variance by 18% and 16% respectively. In the follow-up, illness perceptions explained a significant but modest share of variance in change in health status and QOL when baseline health status and QOL and CHD severity were adjusted for more symptoms being attributed to CHD, severe perceived consequences of CHD, as well as a weak belief in the controllability of CHD were related to poor global health status and QOL ratings. In structural path models associations of CHD severity factors were mediated by illness perceptions. The association of disease severity with dependent variables was weaker after controlling for illness perceptions. Cognitive representations of CHD contribute to both global health status and QOL ratings and they also mediate the associations between CHD severity and well-being. No gender differences were found in associations of illness perceptions with health status or QOL ratings.

Keywords Attributions - Coronary heart disease - Global health sttaus rating - Global quality of life rating - Illness perceptions

Volume 42, Issue 3, Pages 235-244 (March 1997)

13 of 17

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Survival and psychosocial adjustment to stoma surgery and nonstoma bowel resection: A 4-year follow-up

Received 14 August 1996; accepted 19 August 1996.

Abstract

A prospective 4-year follow-up study was conducted to compare the psychosocial adjustment process and survival rate of 59 stoma patients with 64 bowel-resected nonstoma patients. Adjustment was assessed at 4 months, 1 year, and 4 years after surgery by the Psychosocial Adjustment to Illness Scale, a self-report questionnaire (PAIS-SR). Analyses of covariance demonstrated that both subgroups experienced the same level of psychosocial problems 4 years after surgery. Interestingly, patients with poor early adjustment scores (4 months after surgery) were at significantly higher risk of dropping out because of death and terminal status during the follow-up period (1 and 4 years postoperatively). The presence of a stoma did not influence the risk rate for dropping out. These results demonstrate the need for prolonged psychosocial guidance of outpatients who have been surgically treated for colorectal cancer or inflammatory bowel disease.